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Verruca --- malignant melanoma

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Sep 28, 2006.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    From the New England Journal of Medicine:
    Link to pdf file of image
  2. Admin2

    Admin2 Administrator Staff Member

  3. David Smith

    David Smith Well-Known Member


    Earlier I posted this same NEJM article on Jiscmail but there's not much going on there so I'll put my same reply in here too.

    I was wondering what others look for that rings alarm bells when dealing with lesions that initially appear to be v.p.

    Melignant melonoma would be the most aggressive and important lesion to diff dx i would think but it is not likely to be confused with a verruca. Look for Assymetry, Border irregularity, Colour verigation, Diameter increasing. (ABCD).

    I would think the most likely lesions confused with V.P. might be Epithileoma or Verrucous carcinoma and sqamous cell carcinoma as both look very much like v.p. The former is non metastic and the latter can be extremely metastic and can occur as the result of sun burn. Basal cell carcinomas are more common and caused by sun exposure but rarely metatisise. All these and others can look very similar to a v.p. so if I have any doubts I first refer to my trusted book Cutaneous Disorders of the Lower Extremity and if this gives a suspicious indication I will refer to GP or specialist. I did once find a very large epithileoma sub ungual (verified on referral) but this did not resemble a verruca though.
    I am always suspicious of long term V.P. ( over two years ) that are increaing in size.
    The above article just highlights the need to be on one's guard and not be complacent even in apparently routine treatments.

    This links well with another topic in pod arena dealing with a podiatrist cautioned for incompetence.
    There but for the grace of God go I eh!

    Cheers Dave Smith
  4. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    amelanotic melanoma

    When I was a student on practical assessment, a thirty-something female pt presented with an interdigital lesion that had become painful.
    The only thing that made me go hmmmm... was the fact it was in no area of friction.
    Luckily I was with a surgeon and (I still look at him starry eyed for this) he just said-'amelanotic melanoma.' Biopsied it and voila! Histo confirmed his immediate diagnosis.
    Needless to say I feel sorry for the poor pod who misdiagnosed, it's easy to do.
  5. mahtay2000

    mahtay2000 Banya Bagus Makan Man

    I think it's more understandable that this pod misdiagnosed, unlike another pt of mine who had been getting cryotherapy for 6 mnths on a very painful heel 'verruca.' when he finally was referred on to me and I debrided the HK-a large splinter of glass came out!!
    Isn't it great that we almost know as much about feet as doctors? (A quote from a pt also.)
  6. John Spina

    John Spina Active Member

    Thereis an article in the APWCA's journal,I am not sure which issue that presents a case studyof the exact same thing.I will try to find the issue and article and post it here.

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